Reconstruction of heel defects

In the mechanics of normal walking, the heel plays an important role, and injuries to the heel often result in limitation, and occasionally loss, of that ability. We review the three categories of heel injuries based on their severity and discuss the available methods of treatment for each. We also propose the addition of a fourth category for injuries requiring bony replacement. We discuss the appropriate use of skin grafts, local flaps, pedicle flaps, and vascularized free flaps in heel reconstruction. Successful treatment of heel defects often restores normal and pain-free ambulation.